- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $785.65 / $785.65 / $785.65
| Facility | | $785.65 | $785.65 | $785.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.65 / $865.98 / $1,151.65
| Professional | | $785.65 | $865.98 | $1,151.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,608.80 / $5,122.22 / $8,579.00
| Facility | | $1,608.80 | $5,122.22 | $8,579.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.52 / $1,335.77 / $1,755.99
| Professional | | $745.52 | $1,335.77 | $1,755.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,963.36 / $2,321.94 / $2,990.23
| Facility | | $1,963.36 | $2,321.94 | $2,990.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.44 / $1,386.22 / $1,386.22
| Professional | | $1,177.44 | $1,386.22 | $1,386.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.78 / $1,191.78 / $1,191.78
| Facility | | $1,191.78 | $1,191.78 | $1,191.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.00 / $1,191.78 / $2,135.63
| Professional | | $870.00 | $1,191.78 | $2,135.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,455.87 / $1,455.87 / $1,528.66
| Professional | | $1,455.87 | $1,455.87 | $1,528.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.20 / $1,368.20 / $1,368.20
| Professional | | $1,368.20 | $1,368.20 | $1,368.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,739.91 / $8,579.00 / $8,579.00
| Facility | | $3,739.91 | $8,579.00 | $8,579.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.22 / $897.07 / $1,755.99
| Professional | | $684.22 | $897.07 | $1,755.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.88 / $961.18 / $1,755.99
| Professional | | $695.88 | $961.18 | $1,755.99 |